A nurse should have at least 5 years exp before NP school
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I know several great NP's, all of whom have a strong background in clinical nursing. I also no some not-so-great NP's, all of whom have no background in clinical nursing. I don't think this is a... Read More

No one should become a PA or an NP without direct hospital or clinic experience. I do not want an NP or PA seeing me if they have never worked in their field before.

The only PA program in my state requires two years of paid health care experience. It does not have to be direct patient care experience.

Many "direct entry" NP programs have a gap year between the time you finish the basic RN training and the time you start the advanced practice training. After they get their RN many people work the rest of their way through school either on a ft or pt basis. So even people with no health care experience prior to starting a "direct entry" program usually have a few year's nursing experience by the time they start working.

Taking the accelerated route so to speak into Advanced Practice is not for everyone and is not something I am interested in for myself but I don't see a problem with anyone who wants to do it that way - as long as they can hold their own within reason when they graduate and start working.

Apr 15, '09

My friend's sister did a direct entry CNS program. After getting her RN, she worked for a year at the university hospital to pay down part of her tuition and then started her 2 years of APN training, during which she was also working as a staff nurse. So after graduation, she had three years clinical experience as an RN. She continued working for the university hospital, and went on to a dual degree as an NP.

She still works in that same hospital, and she is an incredibly fantastic RN, CNS, & NP.

I agree that there are some people that couldn't handle the intensity of a program like that...she worked really hard and had NO life (no boyfriend, no family, just working and studying non-stop for YEARS). And I really hope that everyone who considers going into this field really assess what they can handle.

Last edit by touchhealth on Apr 16, '09
: Reason: spelling

Apr 16, '09

I think 3 years is enough before starting an NP. Any less than that for me and I'd worry I hadn't seen or experienced enough to decide on a specialty. And I'd want plenty of clinical time within that specialty as well.

JMO.

Apr 16, '09

I was interested in an advanced degree and when I asked the nurse manager on the stepdown unit where I work for a reference to a university masters program, she read me the riot act! She told me that sometime down the line I would be at a loss because of my lack of clinical experience (I am a new grad). She also gave me a very lukewarm recommendation, but because these programs are so competitive, anything less than a stellar recommendation is basically useless as a reference.
I understood her reluctance, but I also wonder why universities are turning out accelerated program clinical nurse specialists, clinical nurse leaders, etc., in droves. These people had undergraduate degrees in business, humanities, etc., and yet they are now considered "masters prepared"! Having worked with a few of them, and having had to show them how to do basic things like start IVs, etc., I can assure you their masters preparation is fictional - unless they are headed away from the bedside and into management.
So I am ambivalent on this issue. Perhaps masters programs that grant prescriptive powers, like the NPs, should be reserved for those with time in the trenches of at least a year.

The only PA program in my state requires two years of paid health care experience. It does not have to be direct patient care experience.

Many "direct entry" NP programs have a gap year between the time you finish the basic RN training and the time you start the advanced practice training. After they get their RN many people work the rest of their way through school either on a ft or pt basis. So even people with no health care experience prior to starting a "direct entry" program usually have a few year's nursing experience by the time they start working.

Taking the accelerated route so to speak into Advanced Practice is not for everyone and is not something I am interested in for myself but I don't see a problem with anyone who wants to do it that way - as long as they can hold their own within reason when they graduate and start working.

Good point. This is how I view it as well. I'm starting an accelerated BSN program in the fall. I'll have approximately 3 years of experience as an RN before I begin as a licensed practicing NP. I'm going the DNP route, so hopefully I can finish w/in three years. I'm going to go ahead and throw out something I've observed and ask for thoughts on this. As the nursing profession is dominated by women, there are a lot of emotional comments made about things where feelings are irrelevant. I had an RN supervisor who I spoke with about my interests in nursing a few years ago. When I told her I wanted to go the ABSN route and immediately begin work on an NP program afterwards, she made the comment that it wasn't fair that I could do that. She mentioned that when she entered the nursing profession (15 years ago), that was not possible. We had the discussions of the pros and cons of such a speedy entry into an NP program and she couldn't make much of an arguement. Her feelings about the subject gave me the impression that she was envious that this route wasn't available to her. She subsequently made arguments to support her stance that had nothing to do with the quality of the clinician, patient care, or the state of advance nursing practice. Of course, this is my

Universities and licensing agencies make the determination of how much clincal experience should be obtained for the safety of patient and the quality of clinical care. I personally think, if it were a big enough issue, there would be more requirements for clinical experience. Again, just my opinion. Of course, when I finish my BSN program and begin work on the DNP, I'll have a better idea of how this will work for me. But as someone else mentioned, it really is a variable thing. If the NP graduate from a direct entry program is competent and capable, why shouldn't they be able to practice? This is essentially what intern physicians do every day. Of course, the experience prior to the licensure should not count, as it is considered "clinical education." This is a really controversal topic. I'm so glad the original poster brought it up because its helpful to talk about these things and hear the opinions of others.

Last edit by ybq2008 on Apr 16, '09

Apr 16, '09

I am a PNP and worked as a PNP for 5 years before going back to school. In my class, we had 2 students who were right out of nursing school. Both were working while they were in grad school so they were getting clinical experience while in school.

I have several concerns with this. While these 2 where very bright and did well in school, they had a lot harder time than the rest of us who had clinical experience. A lot of the hands on, practical knowledge that you can only get by working they did not have so things that were intuitive for some of us weren't for them. Also, the RN role and the APN role are very different roles. For these 2, they were learning both at the same time and that had to be difficult for them. Finally, the hospital where I work, required 5 years of nursing experience (either as RN or APN) to be hired as an APN. My director of my program did express concern for the direct entry students and their ability to get a job because a lot of employers want some nursing experiance.

The 2 students I had in class with my ended doing fine, but I always wondered if it would have been easier for them if they had just worked for a year or so then went back to school. I think it is a personal decision that everyone needs to make for themselves. Personally, I did not care how much experience they had and it did not affect me at all (I know PP had mentioned that some people expressed some jealousy). My viewpoint comes more from practicality.

A pilot becomes a pilot after so many hrs of being a co-pilot.so I'm on your side on this one.but hay..education has no limit.like they say.you can't teach an old dog new tricks..by so,i mean if they nurse had a bad practice habit.it'll be hard to rectify..by it's easy to teach it the right way to those coming in a fresh...feel my twist?

I don't understand your pilot analogy at all. What????

Apr 16, '09

I thought a pilot becomes a pilot after so many hours flown, NOT being a co-pilot.

Apr 16, '09

The most experienced and knowledgeable nurses I know have a general consensus that it takes about 5 years to become an "expert" in a difficult field. Although this probably varies a bit from person to person, I agree with this general premise. I'm sure there are people who are very smart and can "do" the APN program right out of school. However, as another poster pointed out, I think they will have a difficult time relating what they're learning to clinical practice. Moreover, I believe that once in practice, they will not have the clinical assessment skills necessary to make good decisions. As metioned, nursing practice provides you with a certain amount of basic intuition and practical knowledge that you just can't get from text books. I did very well in school, but I didn't realize how much I didn't know until I started working. There are still a lot of things I don't know. Being an NP is more than having "book smarts". For example, I work with nurse who is very smart, but fairly inexperienced. She triaged a patient the other day and put her in my section. The patient was marked as "urgent" and the triage I report from her was that the patient's 02 sat was 97 percent. I took one look at this lady from across the room and thought to myself "are you kidding me?" Yeah her 02 sat was 97 percent all right, on a NRBM! She was pale and her breathing was shallow and tachypneic. Needless to say she was intubated within the hour, not something I like to do when I have full section of patients. She should have been placed in our "unofficial high acuity area".

That's just one example of book smart not making up for experience. As for getting experience while you go to NP school, I think that this combination might overwhelm someone to the point where they couldn't concentrate adequetly on either. Why should we care? NPs represent the nursing profession. If we send NPs through "diploma mills" then this might cause a negative impact on all nurses. I believe many PA's are concerned about the same thing.

Doctors do not have to do clinicals in between pre-med and medical school. Why should a nurse. I think it is individual. Some need more nursing time others do not. There are a variety of NPs out there. --and of course now there is the push for NPs to have their DNP by 2015; two FNPs of whom I work with only have their ASN and are two of the best FNPs out there

There are several differences between the education standards for doctors and nurses. Most doctors need some kind of medical-related experience before they even go to med school. They practice in the capacity of "doctors" for 2 years before they even get out of medical school (years 3 and 4). Once out of school, they work like dogs through residency, sometimes working up to 80 hours a week for 3-7 years! This is all before they can become a "real" doctor and practice on their own. Once an NP is out of school, she does practice on her own. They are still under the physician's license, but most docs I know and work with give a lot more deference to the NP or PA then to the residents, who they ***** about and hold their hands. Besides, most patients and nurses I know don't have a high opinion of residents (though some are better than others). I had a resident the other day come over from the patient's bedside and ask me to take an automatic blood pressure on the patient. So, naturally, I went into the room while the family watched, put the cuff on and pressed the button. The family member turned to me and said, "He needed you to do that? This guy went to medical school?" Is that really the kind of image you want to set for advanced practice nurses?

Apr 16, '09

Unless there are some major changes in nursing education, I agree that NP students should have clinical experience prior to starting the NP program. Sure, there are a few people out there who would do just fine going straight through. There are also a few people out there who would do just fine without any formal program at all - they are just very talented and motivated people. But educational training programs need to be geared to adequately train the AVERAGE student. The traditional reason NP training is so short is that NP students *ALREADY* had much of the knowledge and experience to dx and tx from their work as RNs and just needed to fill in the gaps and have their competence to perform that work formally approved. That's a very different scenario than direct-entry students or even those with just a few years of experience - which may not even be related to what they are planning to specialize in as NPs!!!

Another related point...
If what NPs are practicing is truly "advanced nursing practice" then they need to learn all about "basic nursing practice" first, right? But is what they are practicing "advanced nursing practice" or is it something else? By traditional definitions, nursing practice does NOT include medical diagnosis or prescribing medical treatment. Yet that's exactly what NPs are doing. We can stretch the definition of nursing practice to include medical dx and txt, but then we have to ask what aspects of nursing practice do NPs need to cover to be considered adequately trained? Maybe they don't need to learn and master all that bedside nurses need to. But currently, all RN programs spend the majority of their clinical training on bedside nursing and it must be crammed into those direct-entry NP programs since an entire RN program must be squeezed in with everything else.

Apr 16, '09

My NP program required at least 2 years of clinical experience IN THE CHOSEN SPECIALIZATION. For the CRNA program, it MUST be in critical care, no exceptions. I think that is wise.

Apr 16, '09

I have given myself the 5 year rule before becoming an advanced clinician for two main reasons. 1) I want to be prepared with a strong clinical background before moving on to an advanced practice. 2) Patients trust that their "advanced practice nurse" has advanced knowledge and experience. I know that is my expectation of the healthcare provider who will be diagnosing my symptoms, ordering my medications, or referring me to the proper specialist.